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As Canada’s governments and health agencies continue to tackle the opioid crisis, the black market for illegal drugs may be hindering these efforts. In the last few years, the country has seen an increase in overdose-related deaths and street drugs laced with these substances. It is this crisis that turned a Toronto pharmacist to an advocate.

“The government is doing a great deal and it’s good that they’re working a lot, in terms of treating the crisis in its current state with things like antidotes and harm prevention methods,” said Kyro Maseh, a pharmacist in Toronto’s Upper Beaches neighbourhood. “But I found very little was being done to prevent the crisis that will inevitably occur in the next 10 years.”

Maseh, who is the manager at Pharmasave, said he realized more awareness needed to be raised after one of this customers told him her son had died from an apparent overdose. Years after that conversation, Maseh is now traveling across the GTA to speak to community members and students about the opioid crisis. He covers a wide variety of topics, and focuses the conversation on the prevalence of street drugs being laced with opioids, like fentanyl.

“It’s to warn them of the potential hazards that’s out there and hopefully deter students or young generations from ever trying any of these substances,” he said. “High school is generally when students will be most exposed to illicit substances — that’s why it’s important to target students at a young age.”

According to Toronto Public Health, preliminary figures show there were 179 accidental opioid toxicity deaths in the city in 2016, and fentanyl was present in nearly 50 per cent of those deaths. The fatality rates due to opioid overdoses is expected to increase again in 2017.

“We’re certainly hearing about increased fentanyl out on the illicit market,” said Rita Shahin, associate medical officer of health at Toronto Public Health. “We know that there’s been an increase in fentanyl in the drugs that people are using.”

Health Canada’s Drug Analysis Service (DAS), a sector that analyzes what substances are found in illegal drugs, finds substances testing positive for fentanyl, has dramatically increased.

Number of samples testing positive for fentanyl (reported by DAS from Jan. 1, 2012, to Sept. 30, 2017):

2012: 217

2013: 446

2014: 809

2015: 1711

2016: 3351

2017: 4568

SOURCE: Health Canada

Breakdown by province from 2012 to 2017 containing fentanyl:

PROVINCES

2012

2013

2014

2015

2016

2017*

TOTAL

Alberta

18

60

182

564

730

625

2179

B.C.

76

124

242

601

1596

2318

4957

Manitoba

2

8

5

15

41

38

109

N.B.

1

8

9

Nfld.

5

1

5

12

23

N.S.

1

2

4

7

NT

4

3

11

18

Nunavut

3

3

Ontario

106

235

325

465

809

1419

3359

P.E.I.

0

Québec

10

14

26

45

113

103

311

Sask.

4

22

14

38

46

124

Yukon

3

3

TOTAL

217

446

809

1711

3351

4568

11102

*2017: Reported by DAS from Jan. 1 to Sept. 30SOURCE: Health Canada

“We know that there’s increased contamination of drugs, so people might be buying heroine or cocaine, expecting to have that drug and not expecting to have fentanyl,” Shahin said. “We’re seeing increased overdoses and we know that’s often due to fentanyl that’s in the drugs. People aren’t expecting to have it there.”

Earlier this year, Toronto Public Health released an Overdose Action Plan, to tackle the growing opioid crisis. The implementations include more overdose training throughout the city, more outreach and education, and increasing the distribution of naloxone Kits. In the coming months, the department also said drug testing strips, provided by the province, will be rolled out at safe injection sites throughout the city.

“We know that the fentanyl test strips will help to provide some information, but there’s problems; which is false negatives where it says there’s no fentanyl when there actually is and false positives,” Shahin explains. “The other problem with the test strips is that it doesn’t tell you how much fentanyl is in there.”

In January, a report is expected to be presented to the Toronto Board of Health to provide an update on the progress of the city’s Overdose Action Plan.

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